Provider Demographics
NPI:1487792438
Name:KOSS, LYNN CAROL (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:CAROL
Last Name:KOSS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:LYNN
Other - Middle Name:CAROL
Other - Last Name:RASKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7021 HIGHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-9725
Mailing Address - Country:US
Mailing Address - Phone:315-446-7652
Mailing Address - Fax:
Practice Address - Street 1:7030 E GENESEE ST
Practice Address - Street 2:THE WHITE HOUSE PROFESSIONAL OFFICES
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1121
Practice Address - Country:US
Practice Address - Phone:315-446-4202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002199-1235Z00000X
NC7025235Z00000X
PASL008739235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist